Specialty Care Referral Navigator

Union Community Care; Pennsylvania; On-site; USD 42,000 - 54,000; Full time

Job summary

Union Community Care is seeking a Referral Coordinator to manage prior authorizations and arrange specialty care for patients in Lebanon, PA. The role connects patients with resources, tracks referrals, and streams information between care teams and specialists to ensure timely access to services.

The ideal candidate will have a high school diploma, excellent phone and customer service skills, healthcare experience, and the ability to navigate changing insurer requirements while maintaining

Qualifications

• High School diploma or G.E.D.
• Excellent telephone and customer service skills.
• Healthcare experience required; prior referrals experience preferred.
• Ability to keep track of frequently changing information and details of insurance companies, policies, practices and patients.
• Work collaboratively with the care teams.
• Ability to communicate in English fluently, including reading, speaking and writing
• Medical terminology

Responsibilities

• Coordinates with patients, specialists’ offices and insurance companies to efficiently obtain prior authorizations for patients who need specialty care appointments and/or diagnostic tests that require prior authorization.
• Coordinates with offices and patients to obtain appointments for patients and submits required documentation to authorize the visit with the payer.
• Keeps up to date with all the insurance companies’ requirements, ensuring that the specific specialties and specialists needed by the patient are covered by the insurance company.
• Understands and follows the protocols for referral and prioritization for each payer.
• Develops a good working relationship with the various specialty offices to facilitate the referrals.
• Maintains current lists of specialist offices, insurances with whom they participate, documentation required, and how to schedule patients with their office.
• Prioritize work in the referrals bucket based on urgency. Communicates regularly with the providers to keep them informed of the progress of the referral through the process.
• Follows up and closes the referral loop per policy.
• Performs all other work-related duties as assigned.

Skills

Telephone skills

Customer service

Healthcare experience

English communication

Medical terminology

Education

High School diploma or GED

Job description

Union Community Care is seeking a Referral Coordinator to manage prior authorizations and arrange specialty care for patients in Lebanon, PA. The role connects patients with resources, tracks referrals, and streams information between care teams and specialists to ensure timely access to services.

The ideal candidate will have a high school diploma, excellent phone and customer service skills, healthcare experience, and the ability to navigate changing insurer requirements while maintaining